Management of suspected pulmonary embolism (PE) by D‐dimer and multi‐slice computed tomography in outpatients: an outcome study

Abstract

To cite this article: Ghanima W, Almaas V, Aballi S, Dö rje C, Nielssen BE, Holmen LO, Almaas R, Abdelnoor M, Sandset PM. Management of suspected pulmonary embolism (PE) by D-dimer and multi-slice computed tomography in outpatients: an outcome study. J Thromb Haemost 2005; 3: 1926-32.See also Schoepf UJ. Computed tomography for pulmonary embolism diagnosis: the making of a reference standard. This issue, pp 1924-5.Summary. Objectives: A prospective outcome study designed to evaluate a simple strategy for the management of outpatients with suspected pulmonary embolism (PE), based on clinical probability, D-dimer, and multi-slice computed tomography (MSCT). Methods: A cohort of 432 consecutive patients admitted to the emergency department with suspected PE was managed by sequential non-invasive testing. Patients in whom PE was ruled out were not given anticoagulants, but were followed-up for 3 months. Results: Normal D-dimer and lowintermediate clinical probability ruled out PE in 103 patients [24% (95% CI 20-28)]. Seventeen patients had normal D-dimer, but high clinical probability and proceeded to MSCT. All patients proved negative for PE. A total of 329 (76%) patients underwent MSCT examination. Pulmonary embolism was diagnosed in 93 patients [21.5% (95% CI 18-26)] and was ruled out by negative MSCT in 221 patients [51% (95% CI 46-56)]. MSCT scans were determined as inconclusive in 15 (4.5%) patients. No patient developed objectively verified venous thromboembolism (VTE) during the 3-month follow-up period. However, the cause of death was adjudicated as possibly related to PE in two patients, resulting in an overall 3-month VTE risk of 0.6% (95% CI 0-2.2%). The diagnostic algorithm yielded a definite diagnosis in 96.5% of the patients. Conclusions: This simple and non-invasive strategy combining clinical probability, D-dimer, and MSCT for the management of outpatients with suspected PE appears to be safe and effective.

Diagnostic yield of CT pulmonary angiography in the diagnosis of pulmonary embolism: A single center experience

“…Estrada-Martin and Oldham developed surveys to determine different opinions among radiologists towards the use of CTPA for the diagnosis of PE, and their results showed that most radiologists chose CTPA as the gold standard to diagnose PE [3]. The agreement with this statement is now based on the evidence available in many studies showing that high diagnostic accuracy has been achieved with CTPA in detecting thrombus in both main and side pulmonary artery branches due to rapid technological developments in CT scanning techniques [4][5][6][7][8][9][10][11]. Another important advantage of CT angiography lies in its ability of examining other structures in the thoracic CT scans in addition to the detection of PE, such as assessment of aortic disease and coronary artery disease which is referred to as triple rule-out protocol due to similar symptoms of chest pain presented by these diseases to the emergency department [12,13].…”

Computed Tomographic Pulmonary Angiography vs Ventilation-Perfusion Lung Scanning in Patients With Suspected Pulmonary Embolism

“…[24][25][26][27][28][29] Two recent cohort studies have evaluated whether a negative CTPA alone can safely rule out pulmonary embolism. Ghanima et al 30 performed a management study in 221 patients in which a negative CTPA was used as a single test to rule out pulmonary embolism. The follow-up venous thromboembolic event rate was 0.6% with 2 patients dying of possible pulmonary embolism.…”

Cost-Effective Diagnostic Strategies in Patients With a High, Intermediate, or Low Clinical Probability of Pulmonary Embolism

“…13 However, the new generation multislice CT scanners were used in this analysis because they can detect peripherally located thrombi in fifth-order branches with 1 breath-hold, 35 with improved sensitivities and specificities. 12,13,17,36 Ventilation and perfusion lung scan. The British Thoracic Society Guidelines 37 suggest the V/Q scan as a first imaging test for PE diagnosis.…”

“…New DD assays with improved accuracy and rapid test results have been introduced since the PIOPED II study and have been clinically validated. 12,16,17 …”